Hierarchy of Mobility Skills

Retrieved from: http://www.iamwellness.com/rise-and-shine-the-pain-free-way/

The order for restoring confidence in mobility starts with bed mobility and increasing all the way to community mobility. The hierarchy of mobility skills is presented in a pyramid where as you move up the pyramid the base of support gets smaller. The largest base of support for someone who is receiving OT services is the bed. This requires no transfers and the client is taught how to move around in order to relieve pressure, adjust themselves, and do basic ADLs. The highest joint on the pyramid is community mobility and driving. This makes sense because the environment throughout the community can be very unpredictable and small spaces means a smaller base of support. In between those two points are mat transfers, wheelchair transfers, bed transfers, functional ambulation for ADLs, toilet and tub transfer, car transfer, and functional ambulation for community mobility. 

It does make sense to me that bed mobility would be on the bottom of the hierarchy because there is not moving out of the bed but instead moving around IN the bed. The remainder is not what I expected. I suppose I never thought about a difference between functional walking to perform ADLs and functional walking to engage in the community. Nor did I think about a mat transfer having its own distinct section. I believe the hierarchy is in this particular sequence because of the ratio between the base of support and level of difficulty for each client has been determined through evidence-based practice. 

While observing in the past, I suppose I saw this hierarchy but never knew that there was a rhyme or reason as to why they were doing wheelchair transfers before toilet transfers but now as an OT student it makes complete sense and keeping the client safety is our number one priority. Learning how to correctly roll someone in bed after they are for instance had a spinal fusion would come before the toilet a car transfer. Following this mobility hierarchy and taking into consideration the clients wants and needs will ensure that they will be as independent as possible while not compromising safety. 

Until next time,

Sam the Student